Peds Exam III- Condensed PDF

Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y 1. Growth Hormone - decreased activity of the anterior pituitary gland Deficiency - delayed bone maturation, delayed linear growth 2. Growth Hormone - below 3rd percentile Deficiency Clin- - grow...

Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y 1. Growth Hormone - decreased activity of the anterior pituitary gland Deficiency - delayed bone maturation, delayed linear growth 2. Growth Hormone - below 3rd percentile Deficiency Clin- - grows less than 2 in. a year ical Manifesta- - well nourished tions - retarded bone age, but skeleton proportions are normal - teeth eruption - exual development is delayed - vocal qualities are not correct - osteoporosis, premature closure of epiphyseal growth plates - short stature - disturbed body image 3. GH deficiency Dx - growth charting and TX - GH replacement therapy sub q injection 6-7X a week at night to mimic body's natural growing pattern - stop tx at bone age of >14 in girls and >16 in boys, achievable height is reached, or growth velocity drops to less than 1 in. a year 4. Precocious Pu- - appearance of any secondary sexual characteristics be- berty fore 8 years of age in girls and 9 years of age in males - increased breast development in females under 8 - increased pubic hair in males under 9 - causes: females accidentally taking mom birth control, increased hormones in products, tumor in males, typically idiopathic 5. precocious pu- - early breast development berty s/sx and dx - genital maturation - sexual hair - testicular growth - greater height than peers - increased potential compromise for adult height - increased risk for early pregnancy - early closure of growth plates - Males: CT/MRI to rule out tumor 1 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - LH, FSH, testosterone, or estradiol elevations - GnRH to confirm dx 6. Congenital Hy- - present at birth pothyroidism - few clinical signs in first few weeks - lethargy most common sign 7. Acquired Hy- - acquired usually during teen years pothyroidism 8. hypothyroidism - S/SX: cold, bradycardia, hypotension, decreased height s/sx, dx, and tx and delayed bone growth, weight gain, muscle hypertro- phy, constipation, large protruding tongue, hypotonia - DX: tested at birth, thyroid levels drawn - TX: synthroid/levo, do not give with soy based formulas, improper dosing can lead to hyperthyroidism 9. Hyperthyroidism - occurs when thyroid levels increase (T3 and T4) - resulting in excessive levels of circulating thyroid hor- mones - primarily in adolescents 11 to 15 - almost always a result of graves disease 10. Hyperthyroidism - s/sx: palpitations, tachycardia, fatigue, irritability, muscle s/sx and tx weakness, restlessness, pruritus, tremors, diaphoresis, heat intolereance, increased growth rate, goiter, frequent bowel movements, increased appetite but weight loss, thirst, anxiety, diffuclty sleeping - TX: propylthiouracil (poor compliance due to excessive sweating), causes leukopenia and liver issues - methimazole used more often than PTU due to de- creased liver side effects 11. PKU - accumulation of phenylalanine in the blood - greater than 20 mg/dL 12. PKU complica- - CNS damage from toxic levels of phenylalanine in the tions blood - phenylalanine cannot be broken down causing very high metabolites in the blood, cannot metabolize proteins 2 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - decreased brain development and s/sx show up at about 4 mo. of age - very musty odor to body, musty urine, seizures around 6 mo. of age, very irritable, rash to body 13. PKU education - early detection is important to prevent mental retardation - routine screening 24 hours after newborn has eaten - restrict high protein foods (meat and dairy) and aspar- tame - "Meet Dirty Dans New Enemies" - meat, dairy, dry beans, nuts, eggs 14. Diabetes In- - disorder of vasopressin/ADH, a hormone that helps the sipidus kidneys regulate the amount of water in the body - not enough of the hormone, or the body cannot secrete it 15. DI complications - buildup of sodium can cause seizures or death and nursing con- - nocturia, polyuria, polydipsia, dehydration, hypernatrem- siderations ia, hypokalemia - evaluate I's and O's frequently - vasopressin given to reabsorb sodium balance 16. Type I diabetes - congenital - insulin deficiency - disruption of pancreatic beta cells causing the body to become dependent of outside sources of insulin to help move glucose into the cells from the blood - polyuria, polydipsia, polyphagia, and always losing weight - insulin is primary treatment 17. Type II diabetes - Insulin resistance - alteration in insulin receptor sites that signal the pres- ence of insulin to move into the cells 18. Diabetes TX and - insulin Management - exercise - nutritional control with carb counting - more active kids = less insulin, more food intake 3 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - stress, illness, or infection may cause a need for more insulin 19. Diabetes PT edu- - insulin regimen must be followed cation - by 8 years of age child should be able to follow regimen and give own insulin - target A1C: 7.5 - body has to breakdown fat as an energy source, so ketones are released - diet: 50% carbs, 15-20% protein, 20% fat 20. Pheochromocy- - tumor of the adrenal gland, causes an excessive release toma of catecholamines leading to HTN 21. pheochromocy- - excessive tumor production, increase in epinephrine and toma s/sx, dx, norepinephrine and tx - tachycardia, sweating, cool extremities, N/V, weight loss, headache, HTN - dx: b/t 6-14 years of age, 24 hour urine to look for catecholamines, CT/MRI - TX: surgery, beta blockers 22. congenital - mutation of a certain chromosome does not allow the adrenal adrenal glands to secrete aldosterone and cortisol hyperplasia - insufficient production of aldosterone and cortisol and an increased production in androgens - production of masculine or secondary sex characteristics 23. salt losing adren- - has to do directly with aldosterone deficiency al hyperplasia - losing a lot of sodium in the urine - SX can occur w/in days - weeks of birth - hyponatremia 24. non-salt losing - not so much an aldosterone DO, bust still a deficiency adrenal hyper- with cortisol, increased ACTH and androgens plasia 25. adrenal hyper- - virilizations (production of masculine secondary sexual plasia s/sx, dx, characteristics in females and tx - males: larger penis, normal scrotum size, will reach full 4 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y penil growth by kindergarten age - females: what appears to be a micro penis externally, however still normal on the inside - dx: 17 hydro progesterone level in newborn screen - TX: lifelong use of glucocorticoids - if salt wasting, salt is added to the infant's formula, and mineralocorticoid is given to replace the missing hormone 26. adrenal hyper- - accelerating height before closure of the epiphyseal plasia complica- growth plates tions - premature sexual development/ pubic and axillary hair - ambiguous genitalia in females - males may not be dx until the have an adrenal crisis - crisis: tachycardia, hypotension, fatigue, weight loss, N/V, metabolic acidosis, encephalopathy, death 27. UTI - infection of the upper and lower urinary tract - bacterial, viral, or fungal in nature, most caused by e.coli - very common in children - risks: urinary stasis, poor hygiene, uncircumcised males in first year of life, sexual activity in young females, VUR 28. UTI s/sx - depend on the location of the infection and age of the child - nonspecific: fever, hypothermia, failure to thrive, poor feeding, vomiting and diarrhea, strong smelling urine, ir- ritability - classic symptoms of lower uti not seen until preschool years 29. UTI DX - urinalysis: clean catch, bag specimen, catheter - renal ultrasound - voiding cystourethrogram - IV pyelogram: look at after first UTI for structural defects - early morning specimens are best 30. UTI management - abx - antipyretics - encourage fluid intake - document I/O 5 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - follow up UA - appropriate fluid intake - proper hygiene - sexual activity concerns - avoid caffeine and constipation 31. vesicoureteral - retrograde flow of urine from the bladder to the ureters reflux and possible the kidneys - 5 stages - stage 1: reflux of urine into the ureter only - stage 5: severe dilation of the ureter and renal pelvis with severely blunted calyces - acquired via UTI obstruction, urine holding, or congenital - reflux prevents complete emptying of the bladder = high incidence of UTI 32. VUR DX and TX - renal ultrasound - VCUG - DMSA scan : only definitive testing - TX: surgery, deflux injection. prophylactic antibiotics 33. Enuresis - repeated involuntary voiding by a child old enough that bladder control is expected - Primary: child never had a dry night - secondary: has been reliably dry for at least 6 months and suddenly begins bed wetting - associated with small functional bladder, stress, infec- tion, or deep sleep DO 34. Hypospadius & - Hypo: urethral meatus located underneath the penis Epispadius - epi: urethral opening located on top of the peni s 35. 6 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y hypospadius and - surgery: usually in 1st year of life (6-12 months) epispadius tx - goals: placement of the urethral meatus at the end of the penis - no circumcision before surgery, foreskin is used for repair - stent or catheter to maintain patency 36. bladder exstro- - posterior bladder wall extrudes through the lower abdom- phy inal wall, can't store urine or fx properly, so results in urine leaking 37. bladder exstro- - exposed bladder covered with plastic wrap phy management - primary closure w/in 72 hours after birth - goals: close bladder and abd. wall, fix urinary incontinence with reservation of renal fx, creation of fx and normal genitalia, goal of correcting and promot- ing later sexual function 38. wilms tumor - common abdominal tumor of childhood - usually asymptomatic, firm, lobulated mass located to one side of the midline of the abdomen - dx: noticeable mass, hypertension, abdominal pain, hematuria, or asymptomatic - TX: multifaceted, chemo, radiation, surgery - DO NOT palpate: can release cancer cells into the ab- domen '''' 39. glomerulonephri- - causes: group a beta strep (strep throat) tis - causes an immune response, inflammation of the glomeruli and changed permeability, causes obstruction, and renal insufficiency - inflammation causes proteins and rbc's to leak into the urine causing hematuria 40. glomerulonephri- - increased BUN and Cr tis dx - decreased GFR - hyponatremia 41. glomerulonephri- - many are asymptomatic tis s/sx - abrupt onset of: flank or abdominal pain, irritability, fever, malaise, 7 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - microscopic hematuria - dependent edema of the feet or ankles - HAD STREP: hypertension, + titer for strep, decreased GFR, swelling, tea colored urine, recent strep, elevated BUn and Cr, proteinuria 42. glomerulonephri- - symptomatic tx tis TX - identify and treat infection with abx - monitor and maintain fluid and electrolyte balance - kayexalate to decrease K+ retention - moderate sodium restriction - diuretics - bed rest is key during the acute stage 43. Nephrotic syn- - alteration in kidney function secondary to increased drome glomerular basement membrane permeability to plasma protein - often secondary to minimal change disease, which is damage to the glomeruli - often causes increased permeability to proteins causing them to leak into urine (low serum protein, high urine protein) - clinical state, not a disease 44. nephrotic syn- - history: has there been exposure to anything nephrotoxic drome dx - charactersitic symptoms: periorbital edema, foamy frothy urine - 3-4+ proteinuria - hematuria - hypoalbuminemia 45. nephrotic syn- - periorbital edema that shifts to abdomen and LE drome s/sx - snug, fit clothing and shoes - pallor 8 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - HTN - irritability - anorexia - hematuria - decreased UOP - urine frothy or foamy - resp. distress from pleural effusion 46. nephrotic syn- - decrease proteinuria drome tx - relieve edema: diuretics, give albumin - prevent skin breakdown - meet nutritional needs - promote rest - daily weights - moderate protein replacement with diet - corticosteroids: prescribed to decrease proteinuria, cuase immunosuppression, decrease inflammation, re- store onctoic pressure, increased BP, increases blood sugar - antihyperteensives - abx 47. corticosteroid - used for 6 weeks, then tapered for another 6 weeks use - up to 14 week use 48. hemolytic uremic - causes: preceded by e.coli syndrome - toxins collect on the glomeruli, renal tubules, and collect- ing ducts - endothelial damage: thrombocytopenia (plts cluster causing decreased plt count), damage to rbc's (hemolytic anemia) - damage to glomeruli: renal insufficiency, hematuria, pro- teinuria, increased BUN, Cr, adn waste products 49. HUS DX/labs and : increased BUN, Cr, and waste products tx - decreeased hgb, hct, and rbs - proteinuria - hematuria - TX: kayexalate to get rid of potassium, low waste [roduct 9 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y diet ( decreased proteins, K+, Na+, and phosphorous, high carb diet 50. HUS clinical - HTN manifestations - edema - pallor - bruising - oliguria - irritability, lethargy, stupor - no urine output for 72 hours = dialysis - increased uric acid, increased BP, adn seizures = dialysis 51. Intussuception - invaginaiton of one part of the intestine into the other - intestine folds into itself like a telescope - mesentery becomes inflamed and an obstruction can occur 52. Intussusception - currant jelly stools (bloody/mucousy) clinical - vomiting manifestations - fever - sausage like mass in RUQ - pain on palpation - healthy baby with sudden abdominal pain and tender- ness - screams and draws legs up - bowel obstruction suspected if abdomen becomes dis- tended and vomiting - if left untreated can lead to necrosis and bowel perfora- tion 53. intussusception - barium enema or hydrostatic reduction treatment - pops bowel back out like a gloved finger - or surgery 54. Pyloric Stenosis - hypertrophy of the circular pylorus muscle that surrounds the pylorus - opening becomes narrowed and prevents gastric con- tents from emptying - stenosis occurs between stomach and the duodenum 10 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - pylorus: opening in which food passes from the stomach to the intestines 55. pyloric stenosis - being hungry and wanting to feed, but vomiting after they clinical manifes- eat tations - s/sx develop w/in 3-4 weeks of life - non bilious vomiting - projectile vomiting - olive shaped mass palpable in the epigastric region - failure to thrive - small bowel movements - metabolic alkalosis from vomiting - reverse peristalsis visualized: instead of food heading towards the anus, contents go backwards towards the esophagus 56. pyloric stenosis - nasogastric tube to prevent excessive vomiting and help treatment the stomach empty - pylorectomy: circular muscle fibers are released, opening the passageway allowing gastric contents to empty - reintroduction of feeding w/in 4-6 hours after surgery - resume regular diet 48 hours after surgery - may initially vomit, but should not after 48 hours 57. volvulus - twisting of the bowel, or intestines on itself interrupting blood flow and causing bowel necrosis - surgical emergency, can cause fatal peritonitis 58. volvulus clinical - bilious vomiting: sudden onset, sign of obstruction manifestations - firm abdomen with extension - irritability - passage of blood stools 59. volvulus treat- - confirm treatment with an upper GI series or contrast ment study - keep pt NPO - administer fluids - ostomy may be needed depending on how much of the bowel is necrosed 11 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y 60. gastroschisis - occurs usually to the right of the umbilicus - bowels are not contained in a "sac", they are exposed to the open 61. gastroschisis - prevent hypothermia treatment - keep sterile, place in warm saline filled sac - respiratory and circulatory compromise: ventilation, keep baby propped on side - abdominal assessment: look at color to ensure perfusion - a "silo" is used to push the bowels back in 62. gastroschisis - baby in warmer nursing - warm sterile saline sac interventions - prop baby on sides - prevent necrosis 63. ompahelcele - occurs throughout the umbilical cord - contents are outside of the body in a "sac" 64. omphalocele - warm saline gauze and plastic wrap to cover it treatment - surgery later ot push it back in 65. cleft lip - craniofacial abnormality - milk will come out of the nose; baby will be congested - trouble with latching 66. cleft palate - palate doesnt form when the tongue fails to fall from the roof of the mouth in utero at 10-12 weeks gestation - trouble with latching and sucking 67. cleft treatment - surgery at 10 weeks and 10 lbs - special bottles - surgery by 1 year 12 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y - logans bow after surgery to keep sutures together - arm restraints to prevent things from going in the mouth - keep sutures cleena - no prone positioning - avoid damage 68. cleft common - middle ear infection consequences - nasopharyngeal infections - sinus infections - hearing loss - speech delay - complex care is needed 69. Hirschsprung's - absence or significant reduction of the parasympathetic Disease ganglion cells in the colorectal wall, causing a narrow, constricted bowel - ganglion cells are responsible for bowel relaxation - ischemia and inflammation of the bowel occur 70. Hirschsprung - bilious vomiting disease - abdominal distention manifestations - failure to pass or ribbon like stools - failure of internal sphincter relaxing - recurrent fecal impactions - failure to pass meconium - poor feeding/failure to thrive - chronic constipation 71. hirschsprung's - bowel x-rays treatment - biopsy of intestine - temporary colostomy - pre op: low fiber, high calorie, high protein tpn - antibiotics if s/sx of enterocolitis appear 72. hirschsprung's - may need frequent enemas and a foley education - abdominal girth will be measured frequently - NPO - NG tube - IV fluids 13 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y 73. Biliary atresia - the absence of some or all of the major biliary ducts, resulting on obstruction of bile flow - present at around 4 weeks of age in term, healthy babies who have resolved physiological jaundice 74. biliary atresia - jaundice returning at around 4 weeks clinical manifes- - initially asymptomatic tations - bruising - acholic stool: clay colored - enlarged hardened liver - dark urine - very slow weight gain 75. biliary atresia - kasai procedure treatment - connects the liver to the small intestine, will eventually need liver transplant - typically only successful of performed in infants 8 weeks old or less 76. appendicitis - obstruction of the appendiceal lumen, causing it to be- come irritated and swollen 77. appendicitis pre- - pain sentation - nausea - vomiting - abd. tenderness - mcburney's point - elevated WBC - if temp greater than 101, expect peritonitis 78. psoas sign - pt raises leg from the hip while examiner pushes down against it - will elicit lower quadrant pain 79. obturator sign - if suspected rupture; causes obturator muscle to become irritated - R leg is flexed at the hip and knee, rotate leg externally and medially, elicits pain 80. 14 / 15  Peds Exam III- condensed Study online at https://quizlet.com/_g33z4y appendicitis - surgery asap treatment - no laxatives, enema, or heat - NPO - IV - ABX: non perforated = single dose broad spectrum be- fore surgery 15 / 15